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Cure Violence: A Scientific Approach, Not a Moral One

Joy Jacobson is a CHMP senior fellow. Follow her on Twitter: @joyjaco

Over the years that I’ve been writing about health care through a nursing lens, I am always impressed, if not outright astounded, by the work being done to further public health. This month, the American Journal of Nursing has published my latest article, “A Cure for Gun Violence,” on a successful epidemiologic model for curbing urban violence.

In 2013 Gary Slutkin, the founder of Cure Violence, gave a TEDMED talk in which he describes how “clustering” works in the spread of disease—and of violence, especially shootings: “The greatest predictor of a case of violence is a preceding case of violence,” he said. In other words, a shooting can have the same effect on a community as any contagion, spreading by close personal contact.

Cure Violence works to interrupt retaliatory violence by training community members to intervene on violent situations, especially in the aftermath of a shooting. This process is powerfully depicted in The Interrupters, an award-wining documentary. After disrupting transmission, the work shifts focus to educating communities, with a goal of establishing new norms for interacting and resolving conflict.

Cure Violence has reduced the number of shootings and deaths from 41% to 73% in the seven Chicago neighborhoods where it was used. Other cities have shown similar successes.

For my AJN report I talked with nurses and others working with Aim4Peace, a Cure Violence affiliate in Kansas City, Missouri. That program’s director, Tracie McClendon-Cole, told me that although some may scoff at the idea of preventing and treating community violence as a contagious disease, they appreciate it when it’s explained to them. She said:

We look at violence disease-colonies the same way we look at cholera disease-colonies. It’s a scientific approach, not a moral one. We’re looking at the brain and behavior and how the disease of violence is transmitted, how it affects group function.

A study published this month in Pediatrics demonstrates the need for this kind of approach. Young people seen in an urban ER for assault-related injuries showed a much higher risk of becoming involved in subsequent violence. Carter and colleagues followed two groups for two years. All were young drug users: one group was seen in the ER for assault-related injuries and the other was not. The researchers found that 59% of the young people treated for assault were involved in firearm violence in some way in the following two-year period, almost all of them as victims—threatened, injured, or killed by guns. Nearly a third were aggressors, as well.

Preventing retaliatory violence is where hospitals can intervene, to profound effect. One recent study (abstract here) showed hospital violence-intervention programs to be effective in reducing rates of injury and reinjury, as well as costs. Those researchers recommend that such programs be implemented in all trauma centers. I’ve gathered some resources for health care providers and others who may want to look into starting such a program.

The National Network of Hospital-based Violence Intervention Programs consists of more than two dozen programs working “to stop the revolving door of violent injury in our hospitals.” The Web site features support materials for starting a hospital program.

Violence Is Preventable: A Best Practices Guide for Launching and Sustaining a Hospital-based Program to Break the Cycle of Violence, produced by Youth ALIVE!, encourages nurses and other clinicians to expand their patient advocacy to encompass policy advocacy.

Preventing Youth Violence: Opportunities for Action.
This 2014 report from the Centers for Disease Control and Prevention proposes that violence against children, teens, and young adults isn’t inevitable and recommends a strategy of collaboration among educators, public health professionals, religious organizations, law enforcement, and business owners.

Contagion of Violence: Workshop Summary. A 2012 Institute of Medicine Forum on Global Violence Prevention convened a workshop to explore the “epidemiology” of violence, including modes of transmission and strategies for interruption. The book is available for free download.

And check out this Cure Violence video that explains the model and shows Aim4Peace community workers in action.

Healthstyles: In Awe of Being Human & Jen Sorensen Political Cartoonist

Tune in to CHMP’s Healthstyles Radio Thursday, April 16th, from 1:00 to 2:00 PM on WBAI, 99.5 FM in New York City and streamed online here. 

In this segment of Healthstyles you’ll hear co-host Barbara Glickstein interview Betsy MacGregor, author of In Awe of Being Human: A Doctor’s Stories from the Edge of Life and Death.  Dr. MacGregor worked as a pediatrician and adolescent medicine specialist at Beth Israel Medical Center for 30 years. She shares reflections on living, healing and dying set amidst the challenging world of hospitals and hospices, the medical professionals who work in them, and the ever-present mystery of life and death. You can find out more about the book here.  Listen to the full interview.

Glickstein then interviews political cartoonist Jen Sorensen a nationally-syndicated political cartoonist whose work has appeared in The Progressive, The Nation, Daily Kos, Austin Chronicle, NPR, Ms., Politico, and many other publications. The recipient of the 2014 Herblock Prize and a 2013 Robert F. Kennedy Journalism Award, she tweets at @JenSorensen

You can listen to the interview

JenSorensen

Healthstyles in produced by the Center for Health, Media and Policy. To hear archives of previous programs search here.

Marijuana Policy

I recently wrote about the Institute of Medicine’s report on Dying in America for the JAMA News Forum. A colleague who read the post pointed me to a PSA that the Institute of Medicine (IOM) subsequently published on having the conversation with family and friends about our end-of-life wishes. At the time, the my computer was not cooperating, so I remembered yesterday that I still needed to view it. I went to the website and found the video. Here is the link: It’s Time to Have the ConversationIt’s quite good and should be shared widely.

But it was the video that automatically popped up after the PSA ended that I found especially intriguing. It was a half-hour IOM video on marijuana policy in the U.S. that provides historical and contemporary views. It’s a fascinating account of how we got to criminalizing marijuana–to the tune of billions of dollars in enforcement costs and untold human costs, particularly for those who were sent to prison for smoking a joint. In one image, the video shows the huge death toll from smoking tobacco and using alcohol, compared with zero deaths from marijuana. The “zero deaths” led me to want more detail on how the deaths for each were calculated, since I imagine that marijuana could be a factor in, for example, a deadly car accident when the driver is a first-time marijuana user. (Years ago, I read a study about the impact of marijuana on driving. It concluded that the danger was in first-time users and that experienced users actually were more cautious in their driving.) However, the video is important because of its straightforward, evidence based presentation and because it’s by the IOM.

The video should be used as a teaching tool for students of policymaking and those who want to understand how the U.S. developed a war on a drug that is probably safer than many of the medications that one can obtain with a prescription (and some that are available over the counter–too many aspirins or tylenol can kill you).

I applaud the IOM for moving beyond what the evidence says on topics and trying to improve how the major messages are disseminated and acted upon. That said, I’m waiting for a member of Congress to discover this video and call for defunding the IOM. Evidence doesn’t seem to matter much in the halls of Congress. Maybe they should smoke a joint.

Diana J. Mason, PhD, RN, FAAN, Rudin Professor of Nursing

Healthstyles: A Tale from the Cribs & Chronic Pain in the news is (mostly) all bad

WBAI

Tune in to CHMP’s Healthstyles Radio Thursday, April 9th, from 1:00 to 2:00 PM on WBAI, 99.5 FM in New York City and streamed online here.  In this segment of Healthstyles you’ll hear this:

TALES FROM THE CRIB

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National Child Abuse Month 2015 logo

April marks the 40th anniversary of National Child Abuse Prevention Month

Kristi Westphaln, RN MSN PNP-PC is a San Diego based Nurse Practitioner with clinical expertise in pediatric emergency health care, pediatric trauma, and child abuse. Westphaln is a Center for Health, Media & Policy (CHMP) Senior Fellow and we welcome her as a c0-producer/host to the Healthstyles Radio production team.

Healthstyles is joining hospitals and health care providers across the nation to provide special homage to this vulnerable population, their families, and the health care teams who advocate for them. Welcome to a special series of segments that will educate, enlighten, and possibly shake you up (no pun intended) about the state of child abuse in our country.

Child abuse is a tough reality to chew on; head injuries due to child abuse are a leading cause of disability, devastation, and death in young children today.

Whiplash shaken infant syndrome, shaken baby syndrome, non-accidental trauma, abusive head trauma… The debate on how to best describe inflicted head injuries in children dates back to the 1940s and the discussion remains heated today. As little science and lots of speculation continues to circulate through the media, this tale from the cribs will provide some clarity to the controversy.  

Join her for a down and dirty analysis of the truths behind shaken baby syndrome, abusive head trauma, and pearls for parents (and people) to help protect children.

Baby brains should not be bumped, bruised, battered, shaken nor stirred.

As disability, devastation, or death may occur.

Breathe, soothe, or step away.

Allow your baby to cry- and live another day.

THE MAZE OF PAIN

Hear host Barbara Glickstein interview Peeney Cowan, founder and CEO of American Chronic Pain Association (ACPA).  Ms. Cowan herself is a person with chronic pain and established the ACPA in 1980 to help others living with the condition. She shares how a multi-prong approach to pain management can reduce pain and improve quality of life.

She says we’re not paying enough attention to pain in the research arena. Chronic pain in the news is mostly bad focusing on the abuse of opioids more than their role in pain management and just one part of a pain management plan.

ACPA’s has been expanding their work to address the unique needs of children and veterans living with chronic pain.

You can listen to the entire program:

Healthstyles in produced by the Center for Health, Media and Policy. To hear archives of previous programs search here.

Live Long And Prosper—Unless You’re a #VICTIMOFPOVERTY

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Richard Dorritie, BSN, RN, is a graduate student in public health nursing at the Hunter-Belleue School of Nursing, Hunter College, City University of New York. The following post is the first in a series he will be writing about poverty and health.

Leonard Nimoy played Spock on the popular Star Trek TV and movie series and commonly advised everyone to live long and prosper. He died at age 83. The advice is great but the truth is: living in poverty robs you of that chance.

Recognition was not my strong suit; I was not connecting illness and injury to anything beyond the treatment needed. I couldn’t see the effects of a living environment or poverty policy in my patients. I was a rookie EMT at the scene with my first cardiac arrest patient. My partner instantly identified the lifeless body despite being propped up in a chair with a cold washcloth on her head. Moving with the speed and determination of an experienced healthcare provider that I would soon gain, my partner started CPR and for the first and last time in my life I witnessed someone perform mouth to mouth resuscitation.

The patient was young, in her early 30s and poor. I was somewhere in my early 20s, high up in the housing projects in an apartment that I can’t remember today, when I really started to understand that many of us are #victimsofpoverty. This young woman died from complications of a ruptured ovarian cyst. She died because she couldn’t afford to seek out a health care provider — she didn’t have access to healthcare.

This data from Minnesota make it quite clear the poor don’t live as long:

Source: Wilder Research, Blue Cross and Blue Shield of Minnesota Foundation

Source: Wilder Research, Blue Cross and Blue Shield of Minnesota Foundation

And more of us are getting poorer:

Wealth-gap-growing.WisconsinPoverty is increasing, and the wealth and income gaps are growing. Being poor, we are more likely to smoke tobacco, not live long, not prosper, receive inferior health care and often delay getting the care we need or just go without it.  Current estimates are that 133,000 people died from poverty in the USA just in the year 2000.

It is time for a change. Leonard Nemoy himself was an advocate for the poor in his time, joining “The Poor People’s Campaign”. It is time for all of us to live long and prosper.

Growing up on a diet of free government cheese and anti-war demonstrations, I was no stranger to disparities of wealth and the accompanying opinions of whether or not we poor people mattered. Opinions about poverty persist today and many continue to question the greed and laziness of those in poverty but never the greed and laziness of those in the top 1% of wealth. Opinions have changed healthcare and safety net policies. After 20+ years of patient care, my quest for social justice has only grown stronger. Driven by caring about the disproportionate burden of illness and injury that are attached to poverty, it is time for me to join the fight by becoming a public health nurse and tackling issues of poverty for more than one patient at a time.

This post launches a series that I will be writing about poverty and health. I invite you to weigh in by posting comments on your own experiences of poverty and health. Please share as a person who lived in or is living in poverty or as a health care provider caring for the ramifications of income disparities in your daily practice. All of us are affected by poverty.

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